Physiotherapy Management for Muscular Dystrophy Patients - Exercises and Treatment

Understanding Muscular Dystrophy and Its Effects on the Body

Muscular dystrophy (MD) refers to a group of genetic disorders characterized by progressive weakness and loss of muscle mass. Over time, MD causes increasing disability and can affect walking, arm/hand function, breathing, heart function, posture, and mobility. While there is no cure for muscular dystrophy, various therapies can help manage symptoms, slow progression, and improve quality of life.

The most common types of MD include:

• Duchenne muscular dystrophy (DMD) Primarily affects boys; symptoms emerge around 3-5 years old.
• Becker muscular dystrophy (BMD) A milder variant of DMD; symptoms emerge in early teens.
• Limb-girdle muscular dystrophy Weakness begins in hips and shoulders before progressing to arms and legs.
• Facioscapulohumeral muscular dystrophy (FSHD) Affects face, shoulder blades, and upper arms first.

While each type progresses differently, they all cause muscle fibers to become increasingly damaged and weak over time. This leads to characteristic symptoms like frequent falls, waddling gait, limited range of motion, trouble climbing stairs, fatigue, and progressively worsening disability.

Goals of Physiotherapy for Muscular Dystrophy

Physiotherapy is a key component of the multidisciplinary care required for muscular dystrophy. The major goals of physiotherapy include:

• Maintaining strength, flexibility, and range of motion in the muscles
• Maximizing mobility and function
• Reducing risk of joint deformities and contractures
• Teaching adaptive strategies to conserve energy and compensate for weakness
• Improving balance and stability
• Slowing loss of muscle mass and progression of symptoms
• Providing support with assistive devices like braces, wheelchairs, etc.

Starting physiotherapy early is critical to establish a baseline of strength and function. As the condition progresses, the focus shifts to maintaining abilities for as long as possible and adapting to evolving needs.

Maximizing Mobility and Independence

Physiotherapists work to maximize mobility and independence through exercises, stretches, assistive devices, and teaching adaptive strategies. They analyze how patients move and function in daily life and determine what limitations need to be addressed. Goals are tailored to each patient's individual abilities and challenges.

For example, physiotherapy might focus on improving posture, balance, and coordination to help keep walking independently for as long as possible. Climbing stairs may require particular training. Getting up from the floor can be practiced. Leg braces or orthotics might help stabilize weak ankles. A wheelchair or scooter could preserve energy for priorities like work or family.

Maintaining Range of Motion

As muscles weaken, joints become more prone to tightness and deformities. Physiotherapists prescribe stretches and range-of-motion exercises to maintain flexibility and prevent contractures. Splints, braces, proper positioning/seating, and serial casting can also help reduce cramping and keep joints mobile.

Areas like ankles, knees, hips, elbows, wrists, and fingers are common targets for intervention. Physiotherapy helps preserve as much flexibility as possible in muscles that are still active while preventing deformity progression in more severely affected areas.

Building Strength and Stabilizing Weak Muscles

While muscular dystrophy progressively weakens muscles, focused strength training can help stabilize weak areas and slow deterioration. Physiotherapists develop individualized exercise programs targeting key muscle groups. This helps keep muscles active and may reduce falls or problems with movement.

For example, leg strengthening exercises can support weak knee muscles to improve stability when walking. Back/core exercises preserve posture and spine health. Gripping exercises maintain hand function. Weight training can be adapted based on current abilities. Water therapy provides gentle resistance. Functional strengthening through daily activities is encouraged.

Conserving Energy

As MD progresses, fatigue increasingly limits activity. Physiotherapists analyze routine tasks and movements to identify areas of excessive or inefficient energy expenditure. They provide tips like pacing activities, proper body mechanics, and energy conservation strategies. This allows patients to maximize participation in meaningful activities without overexertion.

Planning high-priority tasks for times of peak energy can help. Learning the best ways to move, transfer, or carry objects reduces wasted effort. Assistive devices help achieve goals requiring strength or mobility. Keeping large muscles strong preserves overall stamina. Ongoing reassessment helps tailor conservation strategies as abilities change.

Physiotherapy Techniques Used in Muscular Dystrophy

Depending on the current disease stage and functional limitations, physiotherapists may employ techniques like:

Stretching and Range-of-Motion Exercises

Gentle stretches and exercises that move joints through their full range of motion are prescribed to maintain flexibility. This helps prevent painful tightness and joint deformities as muscles lose elasticity. Stretches are held for 30-60 seconds and aim to slightly extend the joint's limits.

Strengthening Exercises

Exercises using weights, resistance bands, or bodyweight provide light strengthening for muscles not yet severely atrophied. This stimulates remaining motor neurons to help slow deterioration and stabilize weak areas. Low weights and high repetitions are recommended.

Functional Training

Practice of day-to-day tasks and movements helps maintain mobility levels for as long as possible. Getting up from chairs, using stairs, walking, balancing, changing positions, transferring, gripping, and fine motor skills can all be integrated as part of the exercise program.

Aerobic Exercise

Low-impact aerobic activities like swimming, walking, or cycling maintain cardiovascular fitness. This supports respiratory and heart health, combats fatigue, and promotes overall wellbeing. Exercises are tailored to each patient's abilities and limitations.

Assistive Devices

Canes, walkers, wheelchairs, braces, splints, gripping aids, adapted cutlery, and other equipment preserve independence, mobility, safety and function. Proper usage and fitting instructions are provided.

Education

Instruction on energy conservation, proper body mechanics, ergonomics, fall prevention, home exercise programs, lifestyle modifications, and adapting to evolving needs helps patients self-manage their condition.

Additional Components of MD Management

While physiotherapy is foundational, muscular dystrophy care requires a multidisciplinary approach. Common components include:

Medications

Corticosteroids like prednisone can slow muscle deterioration in DMD for several years. Other drugs help manage heart function, pain, gastrointestinal issues, bone health, and respiratory symptoms as they arise.

Orthopedic Care

Braces support weak joints and surgically releasing contracted tendons can improve positioning. Spinal fusion may help stabilize progressive scoliosis. Ongoing monitoring helps guide interventions.

Respiratory Support

Cough/breathing aids and mechanically assisted cough devices help maintain lung function. Noninvasive ventilators are introduced as respiration weakens. Oxygen therapy supports blood oxygenation.

Cardiac Treatment

Heart function is evaluated periodically to guide medication use. Pacemakers or other cardiac devices may eventually be required to manage conduction abnormalities in advanced MD.

Nutrition

A balanced high-calorie diet with sufficient protein maintains weight and supports muscle health. Supplement drinks or nutritional support may be needed if chewing/swallowing weakens.

Speech Therapy

Exercises targeting oral motor muscles support breathing, speech, and swallowing function. Communication devices can supplement declining speech. Modified diet textures help prevent aspiration.

Psychosocial Support

Counseling, support groups, education, and social work services help families cope with MD stresses. Maintaining school, work, leisure, and social connection enhances wellbeing.

The Role of the Physiotherapist on the MD Care Team

As a core member of the multidisciplinary care team, the physiotherapist brings specialized expertise in movement, function, and maximizing participation. Key roles include:

• Performing assessments to establish baselines and track progression
• Developing personalized exercise programs that align with patient goals
• Prescribing appropriate mobility aids and braces
• Providing joint stretching and range-of-motion regimens
• Training for functional tasks like transfers, walking, gripping
• Advising on positioning, ergonomics, and body mechanics
• Educating on home exercise programs and self-care strategies
• Fitting for splints or casting to maintain length of tight muscles
• Recommending adaptive approaches as abilities change
• Coordinating with other MD clinicians to optimize quality of life and independence

With their specialized skills, physiotherapists are invaluable in helping those with muscular dystrophy preserve movement, manage symptoms, and participate as fully as possible at home, work, school, and in the community.

The Importance of Ongoing Physiotherapy

Due to the progressive nature of muscular dystrophy, physiotherapy should begin as soon as possible after diagnosis. Frequent follow-up continues through the entire disease course. Consistency is key lifelong physiotherapy sustains abilities longer and manages new challenges as they emerge.

During stable periods, physiotherapy might be scheduled 1-2 times per month. More frequent visits help address changing symptoms or needs. Daily home exercises and self-stretches should supplement professional therapy.

While MD causes inevitable loss of strength, proactive physiotherapy makes the most of existing function at every stage. Small gains can significantly improve quality of life. Even if abilities eventually diminish, maintaining mobility, flexibility, posture, and participation for months or years longer provides invaluable benefit.

In Conclusion

Though incurable, muscular dystrophy progression and disability can be significantly slowed through multidisciplinary treatment. As movement experts, physiotherapists play an integral role in optimizing physical functioning, independence, and wellbeing. Combining personalized exercise, mobility aids, stretching, and lifestyle training supports patients in enjoying full participation in work, family, and community life for as long as possible.

While MD brings increasing challenges, proactive physiotherapy and self-care provide the tools to adapt and thrive in the face of this condition. With appropriate support, those living with muscular dystrophy can continue embracing their passions and pursuing their purpose.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.